Gastric antral vascular ectasia (GAVE), also known as watermelon stomach, is a rare condition affecting the stomach. It is one of the diagnoses to consider in older patients with severe anemia and occult or profuse gastrointestinal bleeding (especially in those with cardiac, liver, or renal diseases).
It can be a significant cause of severe acute or chronic gastrointestinal blood loss in the elderly.
While it is rare, it may account for up to 4% of non-variceal upper gastrointestinal blood loss.
Its pathogenesis is unknown although it is associated with heterogeneous conditions, including various hepatic, renal 6, and cardiac diseases.
Pathognomonic red vascular folds (which have been likened to stripes on a watermelon) may be seen on endoscopic evaluation. A histologic hallmark is the presence of superficial fibromuscular hyperplasia of gastric antral mucosa with capillary ectasia and microvascular thrombosis in the lamina propria.
- prominent, scalloped antral folds radiating to the pylorus
- thickening of the gastric antrum.
History and etymology
It was first described by J A Rider et al. in 1953 3.
- 1. Urban BA, Jones B, Fishman EK et-al. Gastric antral vascular ectasia ("watermelon stomach"): radiologic findings. Radiology. 1991;178 (2): 517-8. doi:10.1148/radiology.178.2.1987618 - Pubmed citation
- 2. Robertson IR, Tait NP, Jackson JE. Vascular ectasia of the gastric antrum: angiographic findings. AJR Am J Roentgenol. 1996;166 (1): 87-9. doi:10.2214/ajr.166.1.8571913 - Pubmed citation
- 3. Rider JA, Klotz AP, Kirsner JB. Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage. Gastroenterology. 1953;24 (1): 118-23. Pubmed citation
- 4. Nguyen H, Le C, Nguyen H. Gastric antral vascular ectasia (watermelon stomach)-an enigmatic and often-overlooked cause of gastrointestinal bleeding in the elderly. Perm J. 2011;13 (4): 46-9. Free text at pubmed - Pubmed citation
- 5. Novitsky YW, Kercher KW, Czerniach DR et-al. Watermelon stomach: pathophysiology, diagnosis, and management. J. Gastrointest. Surg. 2003;7 (5): 652-61. Pubmed citation
- 6. Stefanidis I, Liakopoulos V, Kapsoritakis AN et-al. Gastric antral vascular ectasia (watermelon stomach) in patients with ESRD. Am. J. Kidney Dis. 2006;47 (6): e77-82. doi:10.1053/j.ajkd.2006.02.185 - Pubmed citation